Privacy NOTICE

THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.

Southeastern Regional Mental Health, Developmental Disabilities, and Substance Abuse Services (Southeastern Regional MH/DD/SAS) is a Local Management Entity that monitors the services and supports of the four county behavioral healthcare systems. Southeastern Regional MH/DD/SAS knows that information we collect about you and your health is private. Our Area Authority is required to protect this information by Federal and State law. We call this information "protected health information" (PHI) whether oral, written, or electronic format.

The Notice of Privacy Practices tells you how Southeastern Regional MH/DD/SAS may use or disclose information about you as required by law only the minimum necessary information will be disclosed. Not all situations are described. Southeastern Regional MH/DD/SAS is required to give you a notice of our privacy practices for the information we collect and keep about you. Southeastern Regional MH/DD/SAS is required to follow the terms of the notice currently in effect. We reserve the right to revise the terms of this notice.

Southeastern
Regional MH/DD/SAS May Use and Disclose Information Without
Your Authorization

The information we receive is confidential and release of disclosure of any identifiable information to any individual or agency is prohibited except under the following ethical and legal conditions:

Consumer/legal representative has signed a valid authorization for release of information to a third party. (INFORMED CONSENT)

Consumer is seeking treatment at another facility within the N.C. Division of Mental Health, DD., and Substance Abuse Services and it has been determined to be in the consumer's best interest to disclose information to the facility where consumer is requesting services. (This excludes consumers receiving substance abuse treatment.)
Information may be shared with service provider or contracted agency with Southeastern Regional Mental Health Developmental Disabilities and Substance Abuse Services (if deemed to be in the best interest of the consumer). This excludes consumers receiving substance abuse treatment.

In the interest of public safety. (It is determined by a clinical staff member that consumer that consumer presents a danger to self or others).

In response to a court order and/or subpoena.

In response to a medical emergency, disclosure may be made to medical personnel.

Crimes committed at the program. Crimes against any employee of the program, and any threat to commit such a crime.

In the investigation of life-threatening threats to an elected official.

Disclosure may be made to qualified personnel for research, audit, or program evaluation.
For Health Care Operations, Southeastern Regional MH/DD/SAS may use or disclose information in
order to manage its programs and activities. For example, this information may be used in Utilization
Management to review the quality of service you are receiving from a provider agency.

When information is disclosed based on the "need to know", documentation to support this action shall be noted on the Accounting of Release/Disclosure Form in the LME record. Information disclosed without a signed consent indicates, "disclosed" on the form. As required by 164.514 of the Federal Regulations 45 C.F.R Part 164, we will limit the protected health information disclosed to the amount minimum necessary to achieve the purpose for which the disclosure is sought.

Other Uses and Disclosures Require Your Written Authorization

For other situations, Southeastern Regional MH/DD/SAS will ask for your written authorization before using or disclosing information. You may cancel this authorization at any time in writing. Southeastern Regional MH/DD/SAS cannot take back any uses or discloses already made with your authorization.For Treatment and Payment purposes, federal regulations permit disclosure without your authorization ( 45 C.F.R. Part 164 ). However, other laws require consents in writing. North Carolina G.S. 122C-53(a) states that a MH/DD/SA facility may disclose confidential information if the client or his legally responsible person consents in writing to the release of information to a specified person. The release is valid for a specified length of time and is subject to revocation.

Other Laws Protect PHI. Southeastern Regional MH/DD/SAS has other laws for the use and disclosure of information about you. (G.S. 122-C; 42 CFR Part 2; 45 CFR Parts 160 and 164; N.C. Division of MH/DD/SA Services Confidentiality Rules APSM 45-1)

Your Privacy Rights

When information is maintained by Southeastern Regional MH/DD/SAS other State and Federal laws govern the mental health records.

Right to Request Restrictions on Uses and Disclosures. You have the right to request that we limit the use and disclosure of health care information about you for treatment, payment, and health operations. We are NOT required to agree to your request. If we do not agree to your request, we must follow your restrictions (except in the information is necessary for emergency treatment). You may cancel the restrictions at any time. In addition, we may cancel a restriction at any time as long as we notify you of the cancellation and continue to apply the restriction to information collected before the cancellation.

Right to Request An Alternative Method of Contact. You have the right to be contacted at a different location or by a different method. For example, you may prefer to have all written information mailed to your work address rather than your home address. We will agree to any reasonable request for alternative methods of contact. If you would like to request an alternative method of contact, you must provide us with a request in writing. You may write us a letter or fill out an Alternative Contact Request Form. Alternative Contact Request Forms are available from our Privacy Officer.

Right to See and Get Copies of Your Records. In most cases, you have the right to look at or get copies of your records. You must make the request in writing. You may be charged a fee for the cost of copying your records.

Right to Request to Correct or Update Your Records. You may ask Southeastern Regional MH/DD/SAS to change or add missing information to your records if you think there is a mistake. You must make the request in writing, and provide a reason for your request.

Right to Get a List of Disclosures. You have the right to ask Southeastern Regional MH/DD/SAS for a list of disclosures made after April 14, 2003. You must make the request in writing. This list will not include the times that information was disclosed for treatment, payment, or health care operations. The list will not include information provided directly to you or your family, or information that was sent with your authorization.

Right to Receive a Copy of the Notice of Privacy and Any Revisions Thereafter. You have the right to receive a copy of the notice of privacy and any revisions made thereafter. The terms of this notice may be changed in the future, and these changes will be posted in the waiting room of the agency, and/or posted on the agency website (located at www.srmhc.org). You may also request a copy of the new Notice by contacting the Privacy Officer at 910-738-5261.

YOU MAY FILE A COMPLAINTABOUT OUR PRIVACY PRACTICES

If you believe that your privacy rights have been violated or if you are dissatisfied with our privacy policies and procedures, you may file a complaint either with us or with the federal government. We will not take any action against you or change our treatment of you in any way of you file a complaint.

To file a written complaint with Southeastern Regional MH/DD/SAS, you may bring your complaint to the department or you may mail it to the following address: